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KENTUCKY CVS PHARMACY, L.L.C.
CH048980 LEWIS COUNTY PRIMARY CARE CENTER, INC.
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Covered Entity Details
Entity Name
LEWIS COUNTY PRIMARY CARE CENTER, INC.
Subdivision Name
Lewis County Primary Care Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CH048980
Entity Address
211 KY 59
Building A
VANCEBURG, KY 41179
Grant Number
H80CS00106
Participating Start Date
1/1/1999
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
KENTUCKY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06337
1201 INDIAN MOUND DRIVE
MOUNT STERLING, KY 40353
Pharmacy Comments
Contract Details
Approval Date
1/7/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JERRY UGRIN, CEO
(606) 796-3029
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/7/2022
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